To assist with information accessibility and understanding of requirements, we have created an Adult Foster Care manual. The manual is designed to be beneficial from application through the duration of licensure and provide guidance on what to do with different documents.
To better help providers understand what is required for each visit or need, the webpage is laid out in a different format than the manual.
AFC Manual >
The Incident and Required Reporting Form is a tool to help you meet required reporting. You must report the following to your RLS:
- Immediately report death or serious injury of a resident
- Immediately report diagnosis of communicable disease of anyone who lives or works in the home, or has recently visited the home
- Change in the health status of a caregiver within 24 hours
- Occurrence of a fire that causes damage to the home, requires the services of the fire department, or repairs to the home require a building permit within 24 hours
- Change in the regular membership of the household (non-residents) within 5 days
- Change in a caregiver’s employment status within 5 days
MN Rule 9555.7175 provides full information on reporting You may also have to follow additional reporting requirements for the Life Sharing agency you contract with. They will be able to guide you to ensure 245D reporting requirements are fulfilled.
You may also have to follow additional reporting requirements for the Life Sharing agency you contract with. They will be able to guide you to ensure 245D reporting requirements are fulfilled.
- Caregivers with 0 through 5 years of experience as caregivers in an Adult Foster Care home must complete 12 hours of training annually.
- Caregivers with 6 or more years of experience as caregivers in an Adult Foster Care home must complete 6 hours of training annually.
- All caregivers and household members must complete and provide a certificate of completion of the MN DHS Vulnerable Adults Mandated Reporting (VAMR) Training annually.
- If you care for people who rely on life-sustaining medical equipment, you must receive training from a qualified source and maintain record of that training.
- Except for VAMR training as stated above, there are no specific requirements on where you can obtain training. Some training is available through TrainkLink and DirectCourse. Training must be from a “qualified source” (i.e. health care system, educational institution, certified trainer, etc.). Training can be in any of the topic areas listed in MN Rule 9555.6185, Subp. 2 & 4. If you contract with a Life Sharing agency, you may have additional training requirements to comply with 245D.
In a family AFC home, it is expected that spouses of adult foster care license holders who are not also license holders still provide care and are subject to the above training requirements to comply with 245D.
To ensure compliance with MN Statute 245C, you must complete background studies for all household members age 13 and older, caregivers, volunteers, or others as required.
Use the steps below to initiate a background study:
- Using your provider code, each study subject must create an account using a unique email address, initiate, and pay for the background study. Your RLS can provide the code and more detailed instructions.
- The study subject (person needing a background study) will complete a data collection form and valid ID and send it to the RLS.
- Once the RLS receives the documents and notification that a study has been submitted, the RLS will review the submitted information and compare it to the ID and data collection form.
- The RLS will notify you if the study subject needs fingerprinting. If the study subject is a minor between 13 and 17, the RLS will contact you to discuss options regarding fingerprinting.
If someone who had a background study affiliated with your program is no longer affiliated, you must notify your RLS to ensure they are removed from the roster. Your RLS may ask you additional questions.
You can find more information about background studies here:
Our goal is to help you feel as prepared as possible for your relicensing visit. Please reach out to your Regional Licensing Specialist RLS) if you have any questions about the requirements. You will receive an email from your RLS approximately 2 months in advance of your license expiration to schedule your visit.
Any document with a Sourcewell logo is an optional template. You may use a different form or template if you wish as long as all requirements are met. DHS branded documents and templates are required to be used.
Documents to review
Your RLS will complete these documents during your relicensing visit. It’s a good idea to review these documents ahead of time to make sure you are ready. Requirements on these checklists are the minimum standards outlined in Rule of Statute to ensure resident safety and rights as well as program integrity.
It’s also a good idea to review these additional documents to help make sure you are prepared.
Documents to review and/or complete
You must complete and/or review and provide copies of the following documents to your RLS. You can return these documents via secure email or your RLS will scan the documents during the visit.
List of home documents:
- Family AFC Application (PDF)
- Supplement to Application (PDF)
- Census and Home Information Sheet (PDF)
- Certificate of Compliance Minnesota Workers’ Compensation Form (PDF)
- Complaint and Grievance Procedures (PDF)
- Drug and Alcohol Policy (PDF)
- Emergency Procedures (PDF)
- Escape Plan (PDF)
- Fire Drill Log (PDF)
- Internal and External Maltreatment Reporting Procedures (PDF)
- Program Abuse Prevention Plan (PDF)
- Program Plan (PDF)
You will be asked to complete the following forms if they apply to your home:
- Elderly Waiver Service Termination Policy (PDF)
- Equipment Maintenance Form (PDF)
- Pet Authorization form (PDF) and proof of rabies vaccination
- Well water test results with safe levels of coliform and nitrates
- Background studies and social history for children turning 13 (PDF)
List of resident documents:
- Placement and Demographic Information (PDF)
- Individual Abuse Prevention Plan (PDF)
- Individual Resident Placement Agreement (PDF)
- Management of Funds and Cash Resources (PDF)
- Medication Permissions (PDF)
- Mobility Access Verification (PDF)
- Monitoring Technology Consents, if used
- Notice of Privacy Practices (PDF)
- Resident Rights (PDF)
- Rights Restrictions, if applicable
- Vulnerable Adult Act Summary (PDF)
Your RLS will review all items on the Licensing and Home Safety Checklist. Some key observations your RLS will make are:
- Water temperature (must be 120F or less)
- Operation of exit doors and windows (they must not be fully or partially obstructed and must easily open)
- General cleanliness and condition of the home
- Operation of flashlight and battery radio
- First aid kit contents
- Variance requests
After your visit, your RLS will email you a copy of your DHS license, Home Safety Checklist, and Licensing Evaluation Report.
Off-year visits are required non-renewal visits. These visits are an additional opportunity for you to ensure you are following minimum licensing standards, ask questions to your RLS, and for your RLS to collect annual paperwork.
Documents to review and/or complete
- Census and Home Information Sheet (PDF)
- Certificate of Compliance Minnesota Workers’ Compensation Form (PDF)
- Fire Drill Log (PDF)
- Individual Resident Placement Agreement (PDF) (your RLS will view it has been reviewed by the team within the past year)
- Program Abuse Prevention Plan (PDF)
- VAMR and annual training
You will be asked to complete the following forms if they apply to your home:
- Equipment Maintenance Form (PDF)
- Pet Authorization form (PDF) and proof of rabies vaccination
- Well water test results with safe levels of coliform and nitrates
- Background studies and social history for children turning 13 (PDF)
Some key observations your RLS will make are:
- Water temperature (must be 120F or less)
- Operation of exit doors and windows (they must not be fully or partially obstructed and must easily open)
- General cleanliness and condition of the home
- Operation of flashlight and battery radio
- First aid kit contents
- Variance requests
A change of premise happens when you move from one home to another within the same county. If you are moving near the time your license is due to be renewed, your RLS will instruct you to also complete relicensing forms. If you are moving to a different county, you will need to close your existing AFC license and open a new license in that county.
Please notify your RLS at least 90 days in advance of your move. It is not guaranteed that a change of premise can be completed in less than 90 days.
- Ensure all documents are updated with your new address and information including:
- Program Abuse Prevention Plan (PDF)
- Program Plan (PDF)
- Application (PDF)
- Supplemental Application (PDF)
- Escape Plan (PDF) and Emergency Procedures (PDF)
- Updated well water testing, if applicable
- You must select a date that you want your license to update to your new address (you cannot stay with residents at the new address prior to the change or at the previous address after the change)
- Once all documents have been received and any citations from the Fire Marshal inspection have been completed, a final walk through will be conducted by your RLS
- Capacity Change Guidelines and Request Form (PDF)
- Fire Extinguisher Reservicing Options (PDF)
- Planned Leave Substitute Caregiver Plan
- Program Abuse Prevention Plan – sample (PDF)
- Program Plan – sample (PDF)
- Resident File - sample
- Social history form – child (PDF)
- Social history form – adult (PDF)
- Prescription Drug Disposal Collection Bins (PDF)
- Notification of Residential Placement
- Ceiling Height Variance Request (PDF)
- Complaint Investigations (DOC)
Questions
Contact licensing@sourcewell-mn.gov or call 218-895-4120.
Please include your county of residence in all communications.